Case study: When doctor burnout becomes an ethical issue

Optometry has reached historic heights. Today, doctors of optometry are at the top of their game as far as scope of practice, technology at their disposal and respect for the profession.

Still, the profession can take an emotional toll on physicians, which is laid out in a new case study by AOA Ethics and Values Committee guest contributor Jeffrey Weaver, O.D., MBA, M.S., interim dean and professor at Pennsylvania College of Optometry at Drexel University. Dr. Weaver says physician burnout—exacerbated by a growing demand for services and the lingering effects of the COVID-19 pandemic—can raise ethical concerns.

“Optometrists, like other health professionals, are expected to adhere to ethical standards,” Dr. Weaver writes in “Ethical Implications of Burnout."

“This includes integrity, competence and a concern for the well-being of their patients. However, when individuals experience burnout, their ability to meet these ethical standards can be compromised.”

What is physician burnout?

In 2019, the World Health Organization (WHO) included “burnout” in its 11th revision of its International Classification of Diseases (ICD-11). It was not classified as a medical condition but as an “occupational phenomena.” Its definition for the phenomena: “Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

Burnout, according to Dr. Weaver, is characterized by feelings of:

• Emotional exhaustion
• Depersonalization, negativism, or cynicism toward a job
• Reduced personal effectiveness or accomplishment

The WHO issued three years later an evidence-based guideline on mental health at work. 

Dr. Weaver notes that all three of the above characteristics can be related to burnout and details how in the case study.

Providing high-stress care

The usual stressors intensified during the COVID-19 pandemic, which erupted in the news in early 2020 and complicated practice, write the authors of an article in the International Journal of Environmental Research and Public Health published in March 2023.

“Lack of personal protective equipment, work overload, poor infection control, exposure to infected patients, and pre-existing medical conditions were identified as some of the risk factors for increased stress among HWs (health workers) during COVID-19. During the epidemic, physicians experienced other stressors that contribute to their burnout, such as fears of taking the infection home to their family, increased demands for childcare during increased work hours and school closures, concern about their organization’s support of their personal and family needs if they develop an infection, and lack of access to up-to-date information and communication.”

But burnout risks pre-existed the pandemic in the profession. Doctors have always felt the pressure to perform at a higher level. Consider, too, their heavy workload and their serious approach to providing care as “their decisions and actions impact human lives,” Dr. Weaver says.

Dr. Weaver explains that burnout can be a concern if professional competence impacts decision-making and judgment in patient care. Loss of empathy, for instance, can lead to a failure to uphold the ethical standards of respect and dignity, he says.

“Ethically, any health care provider is obligated to provide competent care, and burnout undermines the ability to fulfill this duty,” Dr. Weaver says.

He closes with a series of solutions—among them preventing or mitigating burnout as an organization, reasonable workloads, self-care and access to mental health support.

“Addressing burnout is not just a matter of supporting health care workers—it is an ethical imperative that safeguards the integrity of the health care system,” Dr. Weaver says.

Have an ethical dilemma?

The AOA Ethics and Values Committee routinely produces hypothetical case studies concerning ethical challenges and how best to approach such situations based on the AOA Standards of Professional Conduct, AOA Code of Ethics and the Optometric Oath. Access these case studies through AOA’s member-exclusive, centralized education portal, the AOA’s EyeLearn Professional Development Hub.

Have an ethical challenge or question you wish to share? Submit your idea or a case description to legal@aoa.org. The case description may be reviewed by the AOA Ethics & Values Committee.